Safe Medication Administration Preparation Guide C.O.R.E Essentials

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1 Safe Medication Administration Preparation Guide C.O.R.E Essentials As a new IU Health employee, a portion of your orientation will focus on Safe Medication Administration practices. You will participate in a Safe Medication Administration Assessment during Phase 1 of C.O.R.E. Essentials. This packet contains some guidance for preparation for that activity, a list of Safe Medication Administration resources available to IU Health employees, as wells as a set of practice questions. Please take the opportunity to review and prepare. You may also use a calculator and the enclosed conversion chart. The Assessment will include several key points of Safe Medication Administration practices expected at IU Health. Such as those listed below: A. Proper use of Decimals B. Metric system C. Converting measurements D. Intravenous infusion/push rates E. Medication Compatibility F. Do Not Use Abbreviations (DNUA) and Appropriate substitutions G. The 5 +2 Rights of Medication Administration H. High Alert Medication Practices at IU Health I. Requirements of Patient Identification and Allergy Confirmation at IU Health J. Appropriate Patient Education surrounding Medications K. Nursing Considerations and Interventions surrounding Medications L. Identification and Confirmation of Patient Allergies M. Identification and usage of Approved IU Health Resources and Equipment The 5 +2 Rights of medication Administration: At IU Health any employee who administers medication is responsible for utilizing the 5+2 Rights with every dose. While we do employ some technology to assist with this process, nothing replaces the health care professional at the bedside. You are expected to know and use the following 5+2 Rights as a consistent practice for Safe Medication Administration: 1. The Right Patient 2. The Right Medication 3. The Right Dose 4. The Right Route 5. The Right Time 6. The Patient s Right to Refuse 7. The Right Documentation 1

2 Patient Identification: At IU Health, a minimum of 2 patient identifiers should be used prior to every medication dose. Appropriate Patient Identifiers are: 1. Patient Name 2. Patient Medical Record Number 3. Patient Date of Birth Resources available at IU Health: Through the PULSE PAGE (NURSE PAGE): Lexicomp Micromedex IV Compatibility Search High Alert Medications Policy (MD 1.34AP) DNUA List: Through the Methodist Medical Library: Math for nurses: a pocket guide to dosage calculation and drug preparation/mary Jo Boyer; consultant, Elaine Dreisbaugh. Radcliff & Ogden s calculation of drug dosages: an interactive workbook/sheila J. Ogden. 2

3 Practice Problems 6 kg = lbs 10 lbs = kg 20 kg = lbs 48 lbs = kg 6 oz = ml 45 ml = oz ½ oz = ml 120 ml = oz 4 tsp = ml 10 ml = tsp ½ tsp = ml 5 ml = tsp Dosage Calculation Examples: Below are some examples of different calculation formulas that may be helpful to review. You may know another formula that you re used to using..... that is perfectly fine. Use what works for you. Let s look at an example question worked out using several different formulas: Lasix 18 mg IV is ordered. The ampule is labeled 10 mg/1 ml. How many ml s would you give? Formula 1) dosage available = dosage desired quantity available x (quantity desired) Step 1: 10 mg = 18 mg 1 ml x Step 2: 10x = 18 use cross multiplication Step 3: 10x = 18 = x = 1.8 ml Formula 2) dosage desired x quantity available = x dosage available Step 1: 18 mg x 1 ml 10 mg 3

4 Step 2: 18 mg = 1.8 x 1 ml = 1.8 ml 10 mg Formula 3) dosage desired x quantity available x dosage available Step 1: 18 mg x 1 ml = x 10 mg Step 2: 18 x 1 = 18 X x 10 = 10 multiply across the top row and bottom row IV Drip Rate Calculations Step 3: Divide bottom into top 18 = 1.8 ml 10 Below is an example using the IV drip rate formula of: gtt rate or ml/min = ml (ordered time) x drip factor time in minutes Let s look at an example question using this formula: The order reads D5LR to infuse at 125ml/H. The macrodrip, primary tubing set delivers 15gtt/ml. How many drops per minute are needed to deliver the ordered dose? Step 1: 125 ml/hour x 15 gtts/ml 60 minutes Step 2: 125 x Step 3: 1875 = 31.3 gtts/min 60 4

5 PRACTICE MATH PROBLEMS A medication order is listed at the beginning of each problem. Please figure the correct dosage to be administered in the following problems and place your answers on the numbered blank answer sheet. 1. All answers must be reduced to the lowest terms and expressed in correct annotation. 2. Exact answers are required. Label answer with measurement unit (ml, tablet, gtt/min, etc.) 3. If you are expressing a fractional answer in the form of a decimal, round off to tenths. 4. In figuring the dosage for a tablet preparation and the answer comes out to be ½ of a tablet, you may assume for this exam that the tablet is scored into halves. 5. Calculators and the conversion chart may be used. Practice Applications (Show all work) 1. A baby weighs 6000 gm. How many kg does he weigh? 2. Chloramphenicol 60 mg is ordered. The vial is labeled 1 gm/10 ml. How many ml would you give? 3. Lanoxin 0.02 mg is ordered. The bottle is labeled 50 mcg/ml. How many ml would you give? 4. Lasix 18 mg IV is ordered. The ampule is labeled 10 mg/ml. How many ml would you give? 5. Ampicillin is labeled 250 mg/ 5 ml and comes in a bottle containing 120 ml. A child is discharged on 250 mg q 6 hours. How many tsp. would you instruct the mother to give every 6 hours? How many days will the bottle last if the child receives the medicine q 6 hours? 5

6 6. Your patient is 5 years old and weights 40 pounds. The doctor orders Tylenol 10mg/kg. The bottle is labeled 160 mg/5ml. How many ml of Tylenol would you give? 7. The doctor ordered Nafcillin 640 mg IV q 6 hours. The bottle comes labeled Nafcillin 1 gm/4 mls. How many ml would you give? 8. Lanoxin/Digoxin 60 mcg is ordered. The bottle is labeled 50 mcg/ml. How many ml would you give? 9. Tylenol elixir comes 325 mg per 12.5 ml. The doctor ordered 260 mg. How many ml would you give? 10. IV order reads to infuse one liter of D10W + 40 meq NaCl/L and 4 meq KCl/L to run at 14 ml/hr. The soluset delivers 60 gtts/ml. How many drops per minute are needed to deliver the ordered dose? 11. The order reads infuse 40 meq of KCI in 500 ml D5W over 5 hours using microdrip tubing (60 gtts/ml). How many drops per minute are needed to deliver the ordered dose? 6

7 12. The physician has ordered potassium penicillin G 125,000 units by injection for your patient. You have available a vial of powdered potassium penicillin G labeled 1,000,000 units. Please solve using one of the dilutions using the label below. A. Which diluent amount did you select? B. What volume of the final concentration would you administer? Preparation of solution: Diluent Added Final Concentration 9.6 ml 100,000 units/ml 4.6 ml 200,000 units/ml 3.6 ml 250,000 units/ml 13. The physician has ordered Prednisone 12.5 mg to be given orally. Available are Prednisone in each of the following dosages. The fewest number of whole tablets needs to be given. What combination of the tablets would you give? PREDNISONE TABLET, USP LOT NO: C6J2598 EXP DATE: JUN 05 Mfg. for: SCHEIN FLORHAM PARK, NJ USA PREDNISONE PREDNISONE 10 mg 5 mg 2.5 mg TABLET, USP LOT NO: C6K2813 EXP. DATE: AUG 05 Mfg. for: SCHEIN FLORHAM PARK, NJ USA TABLET, USP LOT NO: EXP DATE: OCT 05 Mfg. for: SCHEIN FLORHAM PARK, NJ USA tab tab tab 14. How much medication is in the syringe filled to the arrows below? 7

8 15. How much medication is in the 1 ml TB syringe below as indicated by the arrow? IU Health provides oral syringes as Safe Medication Administration devices. The amber color and nonleur tips which are not compatible with IV access ports, allow staff to differentiate these oral only syringes. For Safe Medication Administration, oral solutions should be drawn up in an oral syringe. 8

9 The following example illustrates the type of exercises on the Safe Medication Administration Assessment Medication Name Ferrous Sulfate 325mg Tablets Medication Dosage Ordered Dose: 650mg Dosage Calculation (How many ml s, tabs or gtts?) The nurse will give 2-325mg tablets Side Effects/ Adverse Reactions Abd pain, nausea, constipation, diarrhea, black colored stools Nursing Implications Do not crush Do not take within 2 hours of taking an antacid Take 1 hour before or 2 hours after coffee, dairy, or eggs Other Answer Key Practice Problems 6 kg = 13.2 lbs 10 lbs = 4.5 kg 20 kg = 44 lbs 48 lbs = 21.8 kg 6 oz = 180 ml 45 ml = 1 1/2 oz ½ oz = 15 ml 120 ml = 4 oz 4 tsp = 20 ml 10 ml = 2 tsp ½ tsp = 2.5 ml 5.0 ml = 1 tsp Practice Application 1. 6 kg ml 12. A. 9.6 ml A. 4.6 ml A. 3.6 ml ml ml ml ml ml 9. 10ml 5. 1tsp 6 days gtts/min gtts/min mg tab 0-5 mg tab mg tab ml ml B. 1.3 ml B. 0.6 ml B. 0.5 ml 9

10 CONVERSION CHART 5 ml = 1 tsp 1000 gm = 1 kg 1000 mg = 1 gram (gm) or (Gm) 1000 mcg = 1 mg 30 ml = 1 ounce 2.2 lb. = 1 kg gtt rate = ml / ordered time x gtt factor Time in minutes 10

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